Unbroken: Accepting who you are and what you need

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What’s up with our personalities and behaviors? Many of us have a diagnosis that has something to do with the way our mind works—and if not, we probably know someone who does. It’s hard to hang out in the 21st century without encountering people who have attention deficit hyperactivity disorder (ADHD), bipolar disorder, anxiety disorder, obsessive compulsive disorder (OCD), depression, autism spectrum disorder (ASD), and other neuropsychological diagnoses.

These diagnoses can help us understand ourselves and figure out what helps us meet our potential. This might involve environmental supports (e.g., a quiet classroom), behavioral approaches (e.g., a mindfulness routine), some kind of therapy or life coaching, friends and partners who get it, or medication.

For some, though, the prospect of a diagnosis is problematic. A diagnosis may seem judgmental, stigmatizing, or overly simplistic. We may ask ourselves:

  • Does this mean I’m not “normal”? Can I be happy with myself as I am? Does this label me?
  • What should I do with my diagnosis?
  • How can it help me?

What’s “normal” & does it matter?

When does a personality trait or behavior become a diagnosis? “I think we are restraining what is perhaps a very normal spectrum of human personalities into a very narrow idea of what is normal,” says Deneil H., an undergraduate at Binghamton University in New York. In our student surveys, this was a common concern.

What we’re talking about is medicalization, “the idea that we’re turning all human difference into a disease, a disorder, a syndrome,” says Dr. Peter Conrad, professor of sociology at Brandeis University, Massachusetts. He specializes in “how conditions get to be called a disease and what the consequences are.”

In recent decades, the diagnostic criteria for many neuropsychological conditions have broadened. “More and more human behavior has been defined as a disorder, especially around the edges,” says Dr. Conrad. “Human problems are increasingly medicalized, especially sadness. Eleven percent of the population has ADHD, according to the CDC. At that rate, it’s something that’s fairly normal and not necessarily a pathology.” This does not mean medicalization is a bad thing; it has helped countless people access treatment and supports that work for them. There are pros and cons.

Like anything, medicalization has risks and benefits.

The risks of medicalization include:

  • Discomfort with the premise that there’s something wrong with us.
  • Neglecting to tackle relevant societal factors, such as discrimination and poverty, that prevent people from meeting their potential. “Medicalizing behavioral issues, like substance abuse, frames them primarily as individual problems as opposed to collective social problems,” says Dr. Peter Conrad, professor of sociology at Brandeis University, Massachusetts.

“I am concerned that other underlying issues may be ignored (the diagnosis could be an easy explanation for a more complicated problem).”
—Online student, State University of New York, Empire State College

The benefits of medicalization include:

  • Reducing any negative judgment attached to certain conditions.
  • Conditions defined as illnesses can be covered by health insurance, improving access to treatment and accommodations.

“It used to be thought that the devil had come to people with epilepsy, but with better medicines and reduced stigma, more people with epilepsy have been able to survive.”
—Dr. Conrad

Got neurodiversity?

Behavioral health and disability advocates are working to change the way that these conditions are understood. Their key point: Different kinds of minds come with different kinds of strengths (as well as challenges). Many unusual thinkers and innovators—people who may have been considered mentally ill, disabled, or eccentric—have made critical leaps in the sciences, arts, and technology.

The concept of neurodiversity acknowledges and helps us accept these natural human differences. “Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general,” wrote journalist Harvey Blume, who introduced this idea to a mainstream audience in The Atlantic (1998); “Cybernetics and computer culture, for example, may favor a somewhat autistic cast of mind.” The neurodiversity concept is particularly associated with autism, but embraces all other neuropsychological conditions too.

In the pro-neurodiversity model, the goal is to help us all thrive without judgment and negativity. “One way to understand neurodiversity is to remember that just because a PC is not running Windows doesn’t mean that it’s broken. Not all the features of atypical human operating systems are bugs,” wrote Steve Silberman in Wired magazine. Silberman is author of the award-winning book NeuroTribes: The Legacy of Autism and the Future of Neurodiversity (Avery, 2015).

How neurodiversity helps

Dr. Christina Nicolaidis, a professor at Portland State University, Oregon, is committed to a pro-neurodioversity approach in her clinical practice and academic research. She points to ways that this mindset supports us:

Valuing ourselves & accepting our needs

“A neurodiversity-based approach can be conducive to dealing with the dissonance between accepting yourself, understanding yourself, and being happy with who you are, while also acknowledging that you may need supports, accommodations, and medical treatments.”

Advocating for ourselves and others

“The neurodiversity movement sees people with disabilities as members of a minority group that have a right to be treated equitably. It encourages you to work towards reducing stigma and discrimination, to advocate for one’s legal rights, and to fight for equal access to health care and other services.”

Accessing health care & other supports

“In my clinical experience, a strengths-based and neurodiversity-type approach is extremely important for helping doctors understand, communicate with, and support their patients.”

“After finally being diagnosed with OCD and ADHD, I am so relieved and feel as though my life has had a totally positive change. I now have so much more freedom and control… When you find a medication that is right for you, you will know, because your life can be so positively different. I believe many people’s lives can be made so much better, but they are not seeking the help they need. No one knows what is normal and what is not; no one knows what goes on in others’ heads.”
—Undergraduate, Temple University, Pennsylvania

“For years I dealt with chronic depression and never knew that I had it. Had there been better education and an openness to discuss the various kinds of depression, I may have been able to get help earlier and could have prevented a significant time of my life not being able to live life to the fullest.”
—Fourth-year undergraduate, Kwantlen Polytechnic University, British Columbia

Access to medical and academic supports
“These conditions are probably under-diagnosed in students due to a general impression that certain feelings (e.g., symptoms of depression or anxiety) are ‘normal’ for being in school. The lack of a diagnosis may severely impact a student’s academic success and/or future (e.g., deciding to drop out of school because of constant anxiety). Identifying/diagnosing these conditions is providing appropriate help to those who need it and who could be successful (e.g., academically) if their condition was treated.”
—Graduate student, University of Massachusetts, Amherst

Self-acceptance
“Recognizing and titling a concern can be invaluable in feeling at peace with that disorder, recognizing its symptoms, and understanding how to manage it.”
—Second-year graduate student, University of Wyoming

Personal choice
“If people want to integrate better into society, then it should be their choice to take the meds.”
—Undergraduate, Humboldt State University, California

Reconciliation of strengths and struggles
“I feel like these ‘conditions’ are fundamental differences in us, that make us unique. People are not broken because they feel compelled to move, or because their minds get more distracted. Of course, it needs to be addressed. We can all use some practices to keep ourselves from acting on impulse.”
—Fourth-year undergraduate, Metropolitan State University of Denver, Colorado

Adjustment to big-picture changes
“The increasing diagnosing of neuropsychiatric conditions could be well within a normal response to our changing society. I am encouraged that there are people taking time out of their day to go seek help. That kind of behavior, at a minimum, will help us prepare for the future.”
—Fourth-year graduate student, Temple University School of Medicine, Pennsylvania

What is perceived to be the problem?
“The conspiracy theory behind doctors over-diagnosing something is that they are paid by the pharmaceutical companies, which is hopefully a bold lie.”
—Recent graduate, Kutztown University, Pennsylvania

“While it is important to consider that neuropsychiatric conditions are real issues people face, it is also important not to ‘textbook’ these people.”
—Fourth-year undergraduate, The College of New Jersey

On the other hand
It is inaccurate to say that physicians are paid to prescribe certain medications. Some physicians do work with pharmaceutical companies (for example, in developing new treatments), or receive gifts or samples from them.

A government website enables you to see any payments and other gifts your doctor or teaching hospital has received from pharmaceutical companies or medical device companies. The “Sunshine Act”—part of the Affordable Care Act (Obamacare)—requires transparency around these gifts and payments.

Is your doctor friendly with Big Pharma? Search here

Many of the challenges that come with disability are intrinsic to our society and culture, not to the disability itself.

“Imagine a world where 99 percent of people were deaf,” wrote Dr. Christina Nicolaidis, a physician and a professor at Portland State University, in the AMA Journal of Ethics (2012). “That society would likely not have developed spoken language. With no reason for society to curtail loud sounds, a hearing person may be disabled by the constant barrage of loud, distracting, painful noises… The deaf majority might not even notice that the ability to hear could be a ‘strength’ or might just view it as a cool party trick or savant skill.” She notes that homosexuality was considered a psychiatric condition until 1973.

“[This] reflects on society not working out for us, not [necessarily the] faultiness of the brain. Our culture is what needs to be diagnosed.”
—Second-year graduate student, Portland State University, Oregon

What’s the problem?
“Though there have been improvements to the diagnostic manual [the physicians’ guidebook to neuropsychological conditions], it is still limiting, vague, and left to be interpreted by the clinical professional.”
—Graduate student, San Diego State University, California

“As someone in the mental health field, there are cases in which people are misdiagnosed, or their symptoms are overpathologized or disregarded. A psychological assessment reflects a snap shot of that person at that particular time, and people’s functioning and circumstances can change. However, on the whole, as much as the conversation around mental health has increased, there are many people who are uninformed and therefore do not seek help when needed. Thus, I believe that [these conditions are] still under-diagnosed.”
—Fourth-year graduate student, University of Windsor, Ontario

On the other hand
The way that neuropsychological conditions are diagnosed and categorized is evolving in line with the research. This is also true of many physical health conditions.

Scientists and physicians now understand that what can look like the same neuropsychological condition likely reflects varying causes and biological mechanisms; for example, one person’s depression may involve different biological pathways than the next person’s. This is probably why people with the same diagnosis respond differently to medications and why a range of treatment options is needed. Similarly, the same biological mechanisms may present differently in people, resulting in varying diagnoses.

Consequently, federal research funding has shifted away from targeting diagnoses. Scientists are focusing instead on specific states of mind—such as anhedonia, a loss of pleasure—and specific biological processes.

Disability advocates diagnose “normality”

The term “neurotypical” arose in the disability community as a label for people who have typically-developing minds. Descriptions of “neurotypical syndrome” are satirical; they make the point that disability and “normality” can be a matter of perspective. For example:

Neurotypical syndrome is a neurobiological disorder characterized by preoccupation with social concerns, delusions of superiority, and obsession with conformity.

Neurotypical individuals (NTs) often assume that their experience of the world is either the only one, or the only correct one. NTs find it difficult to be alone. NTs are often intolerant of seemingly minor differences in others. When in groups, NTs are socially and behaviorally rigid and frequently insist upon the performance of dysfunctional, destructive, and even impossible rituals as a way of maintaining group identity. NTs find it difficult to communicate directly.

Neurotypical syndrome is believed to be genetic in origin. As many as 9,625 out of every 10,000 individuals may be neurotypical. There is no known cure for neurotypical syndrome.

Source: The Institute for the Study of the Neurologically Typical (parody)

Diagnosing geniuses and celebrities, dead or alive, has become commonplace. In the absence of modern neuropsychological testing and openness on the part of the individual, such diagnoses are speculative—but in some cases the evidence is strong.

The super-scientists Albert Einstein (the theory of relativity) and Isaac Newton (the law of gravity) were probably autistic, according to a 2003 article in the Journal of the Royal Society of Medicine.

Thomas Jefferson, our third president, likely had Asperger syndrome (a form of autism), according to Norm Ledgin, author of Diagnosing Jefferson: Evidence of a Condition That Guided His Beliefs, Behavior, and Personal Associations (Future Horizons, 2000).

Richard Branson, businessman extraordinaire and founder of Virgin Group, has acknowledged in interviews that he has dyslexia and ADHD.

Sinead O’Connor has talked about her experience with bipolar disorder. Other candidates for this diagnosis include Kurt Cobain, Marilyn Monroe, Vincent Van Gogh, and Emily Dickinson.

Actor Leonardo DiCaprio, who has OCD, played Howard Hughes, who also has OCD, in The Aviator. “He let his own mild OCD get worse to play the part,” said the psychiatrist who advised him on set (speaking to Scotland on Sunday, 2005).

“The more we learn about the spectrum of neuropsychiatric behaviors in humans, the better we can regulate conditions that may pose a risk to a person’s ability to function. [That said,] I am concerned that there’s an overemphasis on what’s ‘normal’ when we ought to celebrate our differences in varying capacities.”
—Second-year graduate student, Boise State University, Idaho

Spoon Theory

My friend is “running low on spoons.” What does that mean?

Your friend is running out of energy for reasons relating to a disability or health issue—maybe a condition that isn’t visible to others. In the “spoon theory” analogy, spoons represent emotional and physical energy. We start each day with a fixed number of spoons and every action uses some of them up. The more demanding the task, the more spoons it requires. “I’m running low on spoons” is a way to tell friends and family that you need to postpone your plans for the evening (for example). It can help others appreciate when you’re flagging for reasons related to sensory overload, chronic pain, or other challenges.

Sources: Christine Miserandino, https://goo.gl/QKtK44, The Guardian (2012)

[survey_plugin] Article sources

Peter Conrad, PhD, professor of social sciences, Brandeis University, Massachusetts.

Ari Ne’eman, co-founder, Autistic Self Advocacy Network, Washington DC., Former Obama-appointed member, National Council on Disability.

Christina Nicolaidis, MD, MPH; professor in social determinants of health, Portland State University, Oregon; co-director, Academic Autistic Spectrum Partnership in Research and Education (AASPIRE).

AASPIRE. (2014). Healthcare toolkit. [Website]. Retrieved from https://autismandhealth.org/?p=home&theme=ltlc&size=small

Conrad, P. (2005). The shifting engines of medicalization. Journal of Health and Social Behavior, 46(1), 3–14.

Conrad, P., & Bergey, M. R. (2014). The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder. Social Science & Medicine, 122, 31–43.

James, I. (2003). Singular scientists. Journal of the Royal Society of Medicine, 96(1), 36–39. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539373/

Larsen, A. (2013). Neurotypical. [Documentary]. United States: Point of View. Retrieved from https://www.pbs.org/pov/neurotypical/

Martin, R. H. (2010, October 30). ABCs of accommodations. New York Times. Retrieved from
https://www.nytimes.com/2012/11/04/education/edlife/guide-to-accommodations-for-college-students-with-disabilities.html?_r=0

Neurotypical Syndrome. (2002). The Institute for the Study of the Neurologically Typical. [Website]. Retrieved from https://isnt.autistics.org/

Nicolaidis, C. (2012). What physicians can learn from the neurodiversity movement. AMA Journal of Ethics, 14(6), 503–510. Retrieved from
https://journalofethics.ama-assn.org/2012/06/oped1-1206.html

Psychology Research Laboratory. (2014). Maclean Hospital. Retrieved from https://www.mcleanhospital.org/research-programs/psychology-research-laboratory

Schaber, A. (2014, August 28). Ask an autistic: What is neurodiversity? [Video]. Retrieved from https://www.youtube.com/watch?v=H6xl_yJKWVU

Silberman, S. (2013, April 16). Neurodiversity rewires conventional thinking about brains. Wired.com. Retrieved from https://www.wired.com/2013/04/neurodiversity/

Student Health 101 survey, February 2015.

Vickers, M. Z. (2010). Accommodating college students with learning disabilities: ADD, ADHD, and dyslexia. The John William Pope Center for Higher Education. Retrieved from https://www.popecenter.org/acrobat/vickers-mar2010.pdf

Walker, N. (2015). Neurocosmopolitanism. [Website]. Retrieved from https://neurocosmopolitanism.com/

Mind & body: A broader look at disordered eating

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In how many ways can eating be disordered? Anorexia and bulimia are familiar terms, and you might have heard of binge eating disorder. What about orthorexia, rumination disorder, muscle dysphoria, drunkorexia, or night eating disorder? Some are clinical diagnostic terms; some have been coined in the community. These and other terms reflect the broadening recognition that disordered eating, eating disorders, and body image issues can manifest in many different ways—including out-of-control eating, obsessive weight-training, cutting out food groups, abusing certain medicines, skipping meals before drinking alcohol, and more. Often, these behaviors both reflect and reinforce emotional health challenges.

How self-criticism can harm us

In many cases (but not all), disordered eating is related to an urge to more closely resemble a popular physical type. “People often feel that peace with your body is conditional: ‘I’ll accept my body when I lose weight or when I exercise more often,’” says Dr. Megan Jones, clinical assistant professor at Stanford University and chief science officer at Lantern, an evidence-based program for improving body image and reducing disordered eating behaviors.

“However, research shows that when you are less self-critical and improve your body image, you’re actually more likely to do the things necessary to optimize your emotional and physical well-being.”

What do many people with eating disorders have in common?

Body image & shame

Negative body image
Thoughts and behaviors might include:

  • Body-checking: Obsessively checking the mirror, scrutinizing parts of the body, or holding/pinching skin folds
  • Self-scrutiny: Criticizing your own body, in your head or out loud
  • Constant comparison: Comparing one’s own shape and size to that of others

Shame and guilt
Shame and guilt often follow the act of eating. People with eating disorders may feel unworthy of food as a source of nourishment, pleasure, or recovery.

  • Shame is a feeling of being inherently flawed: “I am bad/wrong.”
  • Guilt is feeling regretful about an action or behavior: “I did something bad/wrong.”

Black & white thoughts

Cognitive distortion: Black-&-white thinking
Cognitive distortions are destructive beliefs and self-judgments; these can reinforce eating disorder behaviors. Often, these are learned early in life.

Black-and-white (polarized thinking) is an “all or nothing” mentality that leaves no room for middle ground.

  • Food choices are categorized as “good” or “bad”, “safe” or “unsafe”.
  • Black-and-white thinkers tend to alternate between extreme behaviors specific to food and exercise (all or nothing).
  • Typical thought: “I already blew it by eating that cookie with lunch… Now I’m just going to eat whatever I want for the rest of the day and start over again tomorrow…”

Cognitive distortions

Personalization, mind-reading, and blaming

Personalization

  • Constantly measuring one’s worth by comparing oneself to others
  • Typical thought: “I’m the biggest person in this room.”

Mind-reading

  • Making assumptions about what others think of us without substantial evidence
  • Typical thought: “I hate grocery shopping because when I have lots food in my shopping cart, everybody around me is thinking I’m a fat pig, and I can’t handle that.”

Blaming

  • Taking the victim role: e.g., “They made me feel bad about my body so now I don’t care; I’m just going to binge on whatever I want.”
  • Blaming ourselves: e.g., “My ex broke up with me because I’m not good-looking enough.”

Cognitive distortions

Over-generalization and catastrophic thinking

Over-generalization

  • Taking a small piece of evidence or a one-time event and jumping to conclusions about “always” or “never”
  • Typical thought: “I gained weight this weekend… I will keep gaining weight every weekend for the rest of my life.”

Catastrophic thinking

  • Worrying about worst-case scenarios
    on a regular basis
  • Typical thought: “What if I lose control around food? If I’m alone then it’s possible, and since I will be alone later then it will definitely happen to me…”

Rigidity & isolation

Extreme rigidity

  • Calorie-counting and setting a daily
    calorie allowance
  • Strictly measured portions
  • Food rules: cutting out certain types of food
  • Limited variety; lack of flexibility: eating the same foods or food combinations every day

Social isolation

  • Avoiding social situations centered around food, such as restaurants, birthday celebrations, and holiday parties
  • Stems from fear of being judged or feeling pressured to eat a food that makes them anxious

Student story
“When people [manipulate] the natural way their bodies function with [eating disorder behaviors], it changes their personality, values, and attitude.”
—Randi P., fourth-year undergraduate at Pittsburg State University, Pennsylvania

Official eating disorders & related diagnoses: old & new

In 2013, the American Psychiatric Association updated its categories of eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new diagnostic criteria are intended to support more individualized treatment approaches and achieve better outcomes.

These descriptions are abbreviated; they do not include information on the frequency and duration of relevant behaviors. Eating disorders should be diagnosed by a health care professional with relevant expertise and qualifications.

  • Anorexia Nervosa: Restriction of energy intake (calories) leading to a significantly low body weight, with intense fear of gaining weight and often denial of the seriousness of low body weight; “subthreshold” anorexia nervosa involves similar behaviors with a normal body weight
  • Avoidant/Restrictive Food Intake Disorder: Restrictive eating patterns ranging from feeding problems in infancy to restrictive eating in a young adult afraid of choking or vomiting; the causes are psychological but do not involve distorted body image or weight concerns
  • Binge Eating Disorder: Binge eating not followed by compensatory behaviors; “subthreshold” binge eating disorder involves similar behaviors with less frequency
  • Body Dysmorphic Disorder: Extreme preoccupation with a perceived flaw in appearance, interfering with daily life; not an eating disorder per se, but may accompany one
  • Bulimia Nervosa: Binge eating (eating abnormally large amounts of food, past the point of feeling full, and feeling out of control while eating) followed by compensatory behaviors, e.g., self-induced vomiting, abuse of laxatives and diuretics, or excessive exercise; “subthreshold” bulimia nervosa involves similar behaviors with less frequency
  • Muscle Dysmorphia: Extreme preoccupation with the desire to have a muscular physique; not an eating disorder per se, but may accompany one
  • Night Eating Syndrome: A pattern of eating very late in the evening or in the middle of the night
  • Pica: Repeatedly eating non-food substances, e.g., dirt, clay, chalk, or laundry detergent; most often seen in pregnant women or people with iron-deficiency anemia
  • Purging Disorder: Compensatory purging behaviors without binge eating
  • Rumination Disorder: Regurgitating food, then re-chewing, re-swallowing or spitting it out; may be present with anorexia or bulimia

Eating disorders VS Disordered eating

Eating disorders:

  • Eating disorder refers to a serious psychiatric illness involving intrusive thoughts and actions related to food and weight that interfere with physical, social, and emotional health. “People don’t realize how disturbing [eating disorders] can be until there are dire consequences,” says Jen Rego, a licensed psychotherapist in Marlborough, Massachusetts, who specializes in eating disorders. Eating disorders have the highest mortality rate out of any emotional illness, according to the American Journal of Psychiatry (2009). Causes of death include heart failure and suicide.

Eating disorders vary; they tend to involve behaviors like these:

  • Restricting food intake
  • Binge-eating: consuming large amounts of food in a relatively short time frame, to the point of feeling out of control and uncomfortably full
  • Purging: self-induced vomiting, abuse of laxatives, or diuretics
  • Use and abuse of diet pills
  • Compulsive exercise with the goal of burning calories: More info

Engaging in multiple methods of compensatory behaviors (efforts to purge or offset calories from food) is associated with more severely disordered eating.

Disordered eating:

  • Disordered eating is a broader term that describes an unhealthy relationship with food. All eating disorders involve disordered eating. But someone with disordered eating does not necessarily have a full-blown eating disorder.

Signs of disordered eating include:

  • Abnormal, quirky behaviors and patterns related to food and eating
  • Changes in eating patterns due to temporary stressors, high-pressure events, or an injury or illness
  • Obsession and extreme rigidity around food choices
  • Anxiety related to eating certain foods or eating in certain situations, e.g., with a large group of people
  • Attempts to offset the calories from alcohol consumption (e.g., avoiding food or exercising obsessively)

Screen yourself

What are “orthorexia,” “drunkorexia,” and other unofficial eating disorders?

Orthorexia 
Restricting the type (but not the amount) of food to the point that it negatively affects quality of life: “healthy eating” taken to an extreme. Research suggests “orthorexia” may be related to obsessive-compulsive disorder and may be more prevalent in men than women.

Student story  
“I have seen a lot of people become ‘gluten-sensitive’ as a reason to remove grains from their diet. Many people see food as an enemy and focus on removing it from their life instead of focusing on making good choices that help energize their body.”
—Jessica T., first-year graduate student, Emory University, Georgia

Drunkorexia  
Restricting food or exercising obsessively to compensate for calories from alcohol. Research shows a strong association between heavy drinking, high levels of physical activity, and disordered eating in college students, according to a 2012 study in the Journal of American College Health. “Drunkorexia” is more prevalent among women than men and is motivated by concerns about body weight, according to a 2014 study in the same journal.

Pregnorexia refers to a resistance to gaining weight during pregnancy.

Diabulimia refers to behaviors in people with insulin-dependent (Type 1) diabetes who restrict their insulin to manipulate their weight.

What contributes to disordered eating?

Disordered eating likely reflects a combination of risk factors. Researchers are exploring many of these influences:

  • Genetics
  • Certain personality traits; e.g., anxiety, perfectionism, competitiveness, hyperactivity, and compulsiveness
  • Emotional health issues; e.g., traumatic experiences, addiction, depression, and stress
  • Environmental influences:
    • Idealized media images reinforce
      a narrow definition of attractiveness
    • Dieting in early life is related to eating disorders and obesity later
    • Social pressure and judgment (“body shaming”) contribute to eating disorders and obesity
    • Life transitions can increase exposure to possible triggers
    • Performance pressure—e.g., among athletes—can contribute to stress relating to body weight and shape

Helpline, treatment referrals, support groups, and tool kits

How common is this among students?

How to get along better with your body & your food

Here’s how Marci Anderson, MS, CEDRD (Certified Eating Disorder Registered Dietitian) in Cambridge, Massachusetts, breaks it down:

  • Mindful eating: using the five senses to fully experience foods
  • Self-care: nourishing the body and mind with a range of nutrients
  • Self-worth: feeling worthy of food, health, and happiness
  • Intuitive eating: being in touch with our hunger and fullness cues
  • Flexibility and variety: choosing different foods and meals from day to day, without stress or anxiety

Why body shaming fails and how you can counteract it

Body shaming (criticizing your own looks or someone else’s) can reinforce destructive self-beliefs and drive disordered eating behaviors, according to research. “Body shaming is a huge issue right now. Instead of encouraging people to have the ideal body, we need to encourage the ideal of loving the body you have,” says Sara A., a first-year graduate student at the University of North Texas.

Focus less on weight and body shape in your conversations. You may think you’re complimenting someone by saying, “Have you lost weight?” or “You look like you’ve been working out.” But you’re actually reinforcing the stereotype that thin means beautiful or that muscular means good looking.

Discuss the health and emotional benefits of healthy eating and physical activity, rather than their impact on appearance. For example, ask your friend whether the dance classes are helping him feel stronger or sleep better.

  • Resist criticizing your own body. If your friend or family member criticizes theirs, say, “You know I love you, and it hurts me to hear you say that about yourself.”
  • Worried about your friend’s disordered eating? Here’s how to talk to them about it.

How and why to tune out some of that media stuff

In a recent CampusWell survey, nearly 70 percent of respondents said the media’s portrayal of unrealistic body images affects the way they feel about their own body. Research has shown benefits from interventions that help people become more aware of the influence of the media on their body image, according to an analysis published in BMC Psychiatry (2013).

  • Photoshop® and lighting are extensively used to make actors and models appear thin, chiseled, and flawless. Sometimes, they take things too far. For examples, search online for “Photoshop mistakes.”
  • Many actors dedicate considerable time and energy to diet and exercise, especially if their roles require a certain body type. That’s their job. It’s probably not yours.
  • The media play to our insecurities in order to sell us something—like miracle creams and get-buff-quick products (which don’t work).

“The thing that we have to understand and accept is that those images are unobtainable. Guys will not have flawless bodies with perfect abs, pecs, arms, etc. Similarly, girls will not have thin waists, large busts, larger butts, etc. Eating disorders can happen to anyone… boys too.”
—Michael D., first-year undergraduate, Southwest Minnesota State University

Hang out with people who nourish your self-belief

  • If a friend or family member comments on your weight (positive or negative): “Thank you, I care about my health, but I try not to let my weight be a focus.”
  • When you’re tempted to compare your own looks to someone else’s, try to think about their—and your—positive traits that aren’t related to appearance. What do you admire about their personality? What might they admire about you?

Student story
“Being a black woman in a predominately white culture has taken a toll on my self-image. I still have my struggles about how I look, but having friends who do not emphasize highly unrealistic standards of beauty, and who embrace themselves, has really helped.”
—Third-year undergraduate, Rollins College, Florida

Student story
“The way to overcome a negative body image is to be around people who support you and make you feel good about your body. Once you are around people who love you no matter what you look like, you can really start to love yourself and love your body.”
—Chaminie D., fourth-year undergraduate, San Diego State University, California

How to disempower your inner critic

  • “I like that I can dunk a basketball.” 
  • “I’m really good with kids and can’t wait to finish my degree in elementary education.” 
  • “I’m a pretty darned good computer programmer, if I do say so myself!” 
  • “I’m a supportive and loyal friend.”

“Silencing the inner critic is a key step in the process [of accepting your body]. But it also involves being willing to let go of that critic.”
—Dr. Megan Jones, chief science officer at Lantern, a program for improving body image and eating behaviors

“Make a list of things you like about yourself that aren’t related to what you look like. Everyone has strengths; what are yours?”
—Dr. Rebecca Puhl, deputy director of The Rudd Center for Food Policy and Obesity and professor at the University of Connecticut

“Whenever possible, challenge yourself to think about your body in terms of what it can do instead of in terms of how it looks. For example, if you find yourself feeling bad about how your legs look, remind yourself of all the things those legs do for you. They move you around in the world. They let you dance. Focusing on the functions of your body is a great way to treat your body with more kindness and respect.”
—Dr. Engeln, psychology professor, Northwestern University, Illinois

Get active to help your body and mind support each other

Almost any type of regular physical activity can help people feel better about their bodies, regardless of the effects on their fitness and body shape, according to a 2009 meta-analysis of studies by researchers at the University of Florida.

Student story
“As someone who has struggled with disordered eating and body image since my early teens, I understand the temptation to punish my body. It is very easy to hate yourself in a world that trains you to critique and loathe your body for what it isn’t instead of appreciate it for what it is. Physical exercise forces you to come to terms with the fact that your body is a miracle, and can lead to positive body image and an increased sense of accomplishment and self-worth.”
—Second-year undergraduate, Mount Allison University, New Brunswick

When exercise isn’t working
If you find yourself exercising compulsively or punitively to compensate for what you’ve eaten or drunk, this may be a symptom of disordered eating.

Try a self-guided online intervention

Some internet-based interventions appear successful in preventing and/or treating eating disorders, according to studies. For example, Student Bodies™, an eight-session program developed for college students at risk of eating disorders, is based on cognitive-behavioral therapeutic techniques. Inquire at your campus counseling center about accessing an online (or other) intervention.

Helpline, treatment referrals, support groups, and tool kits



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